Provider Demographics
NPI:1417177882
Name:VITUG, VICENTE ABAD JR (PT)
Entity Type:Individual
Prefix:MR
First Name:VICENTE
Middle Name:ABAD
Last Name:VITUG
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 CLEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4292
Mailing Address - Country:US
Mailing Address - Phone:972-222-3814
Mailing Address - Fax:
Practice Address - Street 1:8615 FREEPORT PKWY STE 225
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-1984
Practice Address - Country:US
Practice Address - Phone:972-812-3299
Practice Address - Fax:866-861-4265
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist